Opinions Needed

[justkaren]

Hi Everyone, I'm feeling a little bit hopeless and quite confused right now and so I figure that I will ask your opinions and/or advice. You don't need to be an expert to respond (I don't think that anyone is in regard to my situation). I just want to know what your gut instincts are. Here is the situation. See my signature line? I am 40 (41 in May) and have lots of disappointments behind me. On the other hand, I always stimulate really well, they get 25, 30 , 35 eggs -even with my cycle 3 months ago at age 40. Our fertilization rates are typically about 65%. Hardly any embryos arrest before day 3 and I typically transfer four embryos at 8 cells grade 1 or 2 (1 being the best). I have always had embryos to freeze on day 3, but the ones that they leave around to try to get to blast don't usually make it to the freezer. I currently have 4 blasts and 6 day 3's left in the freezer. My thaw rates vary from cycle to cycle. Sometimes they are good, sometimes they are pretty bad. I had both tubes removed in Aug due to a hydro on one side and an unresolved ectopic on the other. Since then I have had 1 chemical from a fresh ivf and 1 bfn from an FET. I am blessed to have health insurance that covers ivf, so this is not really a money question.

I'm trying to figure out what to do next. My dh is not really comfortable with DE and I just can't give up yet (I have no kids at all). Here are the options that I am considering.

1. Just try another FET right away with the 4 blasts. My thinking: I have never done a blast transfer and maybe I have just been a bit unlucky since the tubes came out. If the hydro was the problem, you might expect that I would have already gotten pg, but then again, I am 40, so maybe I just need another try.....I like the idea of trying again right away. At least I'm doing SOMETHING.

2. Do an endometrial function test before doing anything else. This is a new (still fairly unproven but promising) test that they do at Yale which looks at biochemical markers that indicate the uterine lining will facilitate implantation. My doctor mentioned it because he has run out of standard things to try. The doctor at Yale does indicate high pg rates in those with "normal" results and very low pg rates in those with "abnormal results". They tweak your FET protocol if the results are abnormal in an attempt to turn them "normal". The problem with this test is that you have to do a mock cycle, so it takes two months just to get a normal results. If you get an abnormal result, then they change your protocol and try again. So it would take 4 months minimum if the result comes back bad (remember, I'm 41 in May). On the other hand, I do not like the idea of transferring embryos knowing that I could have found out if my lining was biochemically abnormal ....See the conflict...

3. Do a fresh cycle with pgd. If I still don't get pg with embryos that pass the pgd test, then I could still go back and think about doing about the endometrial function test. My existing embryos would still be in freezer, I would know more about whether my embryos are as good as they look, and I would have at least gotten both some diagnostic information (the pgd results) along with another attempt to conceive. The problem that I have with this is that I produce so many eggs that I really worry about how hard these ivfs are on my poor ovaries. I don't want to do any more of them than is absolutely necessary.

Sorry this is long. If you have questions, please ask. If you have comments/opinions/advice/ please give them.
Thanks,
Karen

[Camel01]

Karen,
That is really tough. I think I would pick the FET as my last choice b/c I would want to keep those embies on ice after I stopped producing quality eggs on my own.
Next to last I would do the endometrial function test. I think it sounds like a good thing to try but I wouldn't want to spend the 4 months on it if I could get some kind of info from the pgd. That is why my 1st choice would be to do another fresh cycle to get some more totsicles.
I don't think this sounds hopeless at all. I think it sounds like you have a plan and you need to complete that plan within a certain amount of time.
Also, I wouldn't be worried about the toll on the ovaries. As far as I know we are very resilient and you aren't going to need them anymore after a certain time period.
I am nowhere near an expert as I've only done 1 IVF and our big problem is male factor but if I were in your shoes that's what I think I'd be thinking.
Good Luck,
I hope you can get this figured out and get your baby soon!
Leighann

[MegSD]

I voted on going for the new test - remember because you're embies are already formed, your age at transfer shouldn't make too much difference...

Then again, since I've never been lucky enough to have ANY make it to the freezer, I'd be very tempted to put them all back and just hope.

I'm not a "fan" of PGD - too many come back "abnormal" even in young, healthy adults. Many of these go on to have success...

Tough decisions - good luck,
Meg

[Miriam]

For me this is an easy answer to give. I would do the PGD. Alot of woman are not crazy with this however I have a DS with the thanks of PGD. Your lucky that you do produce so many eggs that after they test you might still have a good amount. On both my successful PGD cycles, I only had 1 good embie. Of course I don't produce nearly as many eggies as you do.

Best of luck on making this decision and with your upcoming cycle.

Miriam

[justkaren]

Miriam,
Where did you have your pgd done? If I have to do another fresh cycle, it will be a pdg cycle. I both want the information on how my embryos look genetically, and I am getting to the point where the Down syndrom rate is no longer ignorable.
Karen

[BC-Jrmedic]

Karen,
I sent you a PM but wanted to also add the adeza test does not take 4 months to do. I did mine in 2 weeks.

[BC-KarenS-MI]

Hard to say since I'm not really in your shoes, but I think that I'd go for the test to make sure that the lining wasn't abnormal. At least this way you'd know whether things were alright with your lining or not before proceeding. Good luck & let us know what you decide to do.

Karen

[Hopefull K]

I would do the test first. If you get another BFN, you will always be wondering if that would have turned up something useful in your diagnosis. I did have it done after 8 IVFs, and of course it came back normal, but at least I wouldn't have been kicking myself for not doing it if we'd gotten another BFN. The test takes one cycle, but I didn't have to be medicated, I don't think... maybe I did have to take estrogen tablets or something, but no stim meds. My RE said that if it came back abnormal, they would just adjust meds during the next cycle, not do another mock cycle and test again... but it makes some sense I guess.

Given your great egg production, then next thing I'd try would be PGD. Your age doesn't matter with implantation, so you will always have those frozen tots for use later, after you answer the PGD question (I just got pg at 43).

Best of luck!

[eli]

Knowing myself, I would probably choose option 1 if I were in your shoes. I may be tempted to max out option one- (ie: use all the frozens) before proceding to another plan. Good luck!

[magpiesvn]

Hi Karen
I would go with the test for sure. And I would not worry at all about your age. I don't even think its a factor. So forget about you are nearly 41, that's young still! You are young. I know its hard to decide what to do, just take care and rest assured that whatever your decision, whichever one you decide to go with, there will be positive results for you and a glorious outcome!!!